Cardiac Arrest and Cardiopulmonary Resuscitation (CPR)

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Cardiopulmonary  resuscitation  is  an  Emergency  lifesaving  procedure  performed  when  there  is  sudden  cessation  of  heart  beats.  It  involves  the  combination  of  chest  compressions  and  artificial  ventilation to preserve blood flow to the organs including the brain function. Early initiation of CPR  can double or triple the chances of survival after cardiac arrest. 

Note: HIGH QUALITY CPR 

  • Compressions:
    • Infant: 2  finger  compression  (if  alone)  or  thumb  encircling  technique  (if  you  have assistance)
    • Child: 1 or 2 hand
    • Adult: Two hands
    • Compression rate: 100-120/min
    • Compression depth: approximately 1/3 antero-posterior diameter of the chest
    • Compression/ventilation ratio: 30:2 (adults and children), 30:2 (If alone) and 15:2 (If you have assistance)
  • Allow chest recoil
  • Minimize interruptions
  • Adequate ventilation

Clinical presentation 

  • Unresponsiveness (sudden loss of consciousness)
  • Absence of central pulse (carotid pulse/femoral pulse or brachial pulse in infants)
  • Loss of spontaneous respiration

Investigations 

While continuing with CPR, point of care (POC) tests are conducted while looking for the reversible  causes  of  the  cardiac  arrest  (Hypovolemia,  hypoxia,  hypo/hyperkalemia,  acidosis,  hypothermia,  hypoglycemia, tension pneumothorax, toxins, thrombi, cardiac tamponade). These includes: 

  • POC Blood gases
  • POC Bicarbonates
  • POC Electrolytes- Potassium, sodium, Calcium, Chloride,
  • POC Creatinine, POC urea
  • POC RBG
  • Bedside ultrasound- looking for pneumothorax, cardiac tamponade or thrombi
  • POC Toxicology screens (If available)
  • POC ECG (if there is return of spontaneous circulation)
  • POC lactate
  • POC Troponin

Management 

  • HAZARDS- ensure safety and use of PPEs
    • HELLO-  Check  for  responsiveness,  Carotid  pulse (not  more  than  10  seconds) and breathing
      • CPR starts with early recognition (unresponsiveness, loss of spontaneous breathing and absence  of  carotid  pulse.  In  infant’s  CPR  is  initiated  when  the  heart  rate  is  below  60 beats/min
  • Call for HELP and immediately start chest compression. As more members arrives to help assign  different  roles  including  airway  and  breathing  management,  time  recording, documentation, AED/monitor, medications
    • Open the airway by performing chin lift or jaw thrust (if suspecting C spine injury). Use airway adjuncts to open the airway.
      • Give 2 breaths using bag valve mask connected to oxygen source and observe for chest rise
  • Establish  IV  access  for  administration  of  fluids  and  medications,  if  failed  perform Intraosseous access
    • After  FIVE  cycles  of  compressions/ventilation  (2  minutes),  check  for  pulse  and  use AED/Defibrillator to analyze rhythm if there is a need to deliver shock
  • If no need for shocking continue with CPR for another 2 minutes (FIVE cycles)

Pharmacological Treatment 

A: adrenaline (IV) Adult: 1mg, Pediatrics0.01mg/kg (repeat every 3-5 minutes) 

AND 

A:  0.9%  sodium  chloride  (IV):Adult  2000mls,  pediatrics  20mls/kg;  if  suspecting hypovolemia as a cause of the arrest 

AND 

A: dextrose 5% (IV) if needed to correct hypoglycemia 

OR 

C: dextrose 10%, 25% or 50% (IV) if needed to correct hypoglycemia 

AND 

C: sodium bicarbonate 1mmol/kg (IV) push (if needed to correct acidosis) 

*Additional  medications  maybe  required  depending  on  cause  of  the  cardiac  arrest  (the reversible cause)

Disposition 

Upon  achieving  return  of  spontaneous  circulation  (ROSC),  definitive  airway  is  achieved  by  performing endotracheal intubation for mechanical ventilation and patient must be admitted to the  ICU or transferred to a facility with an ICU capacity.